THE PROMISE AND PRACTICE OF CARDIOVASCULAR RISK REDUCTION - A DISEASEMANAGEMENT PERSPECTIVE

OBJECTIVE: Interpretive analysis of epidemiological, clinical trials a nd practice pattern data for cardiovascular risk reduction in the cont emporary setting of unprecedented demographic changes. DATA SOURCES: L iterature review and audit results of the Clinical Quality Improvement Network (CQIN). DATA SYNTHESIS: Coronary artery disease (CAD) is the largest single cause of death in Canada. CAD is age-related and the po pulation is rapidly ageing, a combination that threatens an epidemic o f future CAD events. Epidemiological data demonstrate a direct relatio n of CAD risk and serum cholesterol levels and no threshold cholestero l level below which there is no CAD risk. The epidemiological data als o suggest CAD risk can be reduced by lowering serum cholesterol and th is hypothesis has now been incontrovertibly confirmed by repeated rand omized clinical trials. Most recently, reduction of all-cause mortalit y with cholesterol lowering therapy in high risk subjects has also bee n confirmed. Despite the overwhelming trials and epidemiological evide nce, CQIN effectiveness analyses reveal far from optimal risk assessme nt and management practices among high risk patients. CONCLUSIONS: Ser um cholesterol is directly related to CAD risk. Reduction of cholester ol reduces CAD, and all-cause, mortality in high risk patients. There is a large window of opportunity to improve lipid-lowering practices, and patient outcomes, for the most deadly diseases in our society.